Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial.

Abstract

Plantar fasciitis is a frequent and painful condition with a lifetime incidence of 10%. Good results have been reported for operative treatment of plantar fasciitis refractory to non-surgical interventions in uncontrolled studies. The aim of this study was to compare the results of operative treatment (endoscopic debridement, removal of the heel spur and partial resection of the plantar fascia) with those of a controlled and supervised non-operative rehabilitation program. Thirty consecutive patients with plantar fasciitis during more than 3months were randomized to either (1) non-operative treatment with corticosteroid injections and a controlled strength training program or (2) an endoscopic 2-incision operation with partial fasciotomy and heel spur removal followed by the same strength training program. Patients were evaluated at entry and 3, 6, 12 and 24months post-operatively with the foot function index (FFI) and pain score during activity on a 100mm VAS scale (VAS activity). FFI at 6 and 12months was defined a priori as primary endpoint. Both groups improved significantly over time. The FFI score was significantly better in the operated group compared to the non-surgically treated group 12months post-operatively (p = 0.033), at 24months this was, however, not significant (p = 0.06). VAS activity at 24months was significantly (p = 0.001) in favor of the operative group. More patients returned to running and jumping in the operative group (p = 0.04). This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. I.